Hip arthroscopy helps elite athletes return to sport

The most common procedures in the series included partial acetabular labrectomy, labral repair.

Issue: Issue 2 2008

Despite being referred late for treatment of hip pain, many elite athletes treated at Wellington Hospital in London successfully underwent safe, effective hip arthroscopic procedures for a variety of hip pathologies.

Patients often returned to the same level of sport within about 4 postoperative months, investigators said.

“Chondral flaps and ligamentum teres tears are underdiagnosed heavily,” said Vikas Khanduja, MRCS(G)-MSc, FRCS (Orth).

During the British Orthopaedic Association Annual Congress 2007 in Manchester, he presented results of a retrospective study of 31 hip arthroscopy procedures in 27 patients (25 men, 2 women).

The investigators sought to prospectively assess the role hip arthroscopy played in treating professional athletes who competed at the national or international level.

Same-day surgery

Hip arthroscopy can be performed with patients in the supine or lateral position. Khanduja and Richard N. Villar, MS, FRCS, operated with their patients positioned laterally. The surgery, which can take up to 2 to 3 hours, required an image intensifier. The investigators used the McCarthy distractor and 70° arthroscopes in all cases.

All patients were discharged on the same day and underwent about 6 to 8 weeks of supervised rehabilitation, Khanduja said.

The patients’ average age was 38 years (range, 18 to 58 years); 65% were professional football players. The rest of the athletes were primarily cricket or tennis players.

Chondral damage emerged during hip arthroscopy as the source of this elite athlete’s pain. The damage occurred after separation.

This torn acetabular labrum was noted to be fibrillated via a hip arthroscopy
Investigators saw this torn acetabular labrum via hip arthroscopy and noted it was fibrillated. They also found the technique effective for diagnosing chondral injuries in this patient population.

Images: Khanduja V

Modified Harris hip score

Before and after surgery, patients underwent a clinical exam and had modified Harris Hip scores determined. Most of them also underwent MRI scans or radiographs of the hip.

“A strongly positive impingement test with a background of appropriate history was a good indication for hip arthroscopy,” Khanduja said.

Patients completed detailed questionnaires preoperatively and postoperatively and were followed up postoperatively at 6 weeks and 3, 6 and 12 months.

One patient underwent bilateral hip arthroscopies. Three others needed two hip arthroscopy procedures on the same hip.

Many labral tears

All patients had a positive impingement test.

“Most of them gave a very prolonged history,” with the average time to referral being 506 days, Khanduja said. One patient was in pain for 5 years following a hip injury before being referred.

Twenty patients ultimately had labral tears, five patients had chondral flaps and two patients presented with ligamentum teres tears. Twenty patients also had chondral injuries that were diagnosed arthroscopically. Investigators reported no complications.

Khanduja urged orthopedic surgeons who see patients like these to refer them early “because they are referred fairly late and underdiagnosed. Perhaps a high index of suspicion and early referral will lead to early intervention and a quicker return to sport.”

For more information:

Vikas Khanduja, MRCS(G)-MSc, FRCS(Orth), is a consultant orthopaedic surgeon, Addenbrooke’s-Cambridge University Hospitals NHS Trust. He can be reached at Hills Road, Cambridge, Cambridgeshire, England CB2 0QQ; +44-1223-245-151; e-mail: vikaskhanduja@aol.com. He has no direct financial interest in any product or company mentioned in this article.

Reference:

Khanduja V, Villar RN. Hip arthroscopy in the elite athlete. Presented at the British Orthopaedic Association Annual Congress 2007. Sept. 25-28, 2007. Manchester.